Blue Cross Blue Shield of Georgia* SmartSense Plus In-Network Benefit Summary
Questions? Call Holly or Chris at 770-396-9517 or click here to send an email
What is an Open Access POS Plan? Click here to find out.

Description of Benefits

SmartSense Plus Open Access POS

SmartSense PlusPPO
Plan Differences Between the POS and PPO Plan - Summarized for Your Convenience 1. Lower Cost
2. Blue Cross Open Access POS Network (No referral req'd)
3. No Pre-Existing waiting period unless specified in approval
4. Coinsurance Out-of-Network Cov'g is 50% after Ded.
5. Child Wellcare Out-of-Network covered at 50%		 1. Higher Cost
2. Blue Cross PPO Network (No referral req'd)
3. 1 Yr. Pre-Ex Waiting Period If No Group Prior Coverage
4. Coinsurance Out-of-Network Cov'g is 40% after Ded.
5. Child Wellcare Out-of-Network is not covered
Lifetime Maximum Per Member

Unlimited

Unlimited
Calendar Year
Deductible Choices
(Separate deductibles apply for in-network and out-of-network)		 Individual

$750
$5,000

$1,500
$7,500

$2,500
$10,000

$3,500
$20,000

$750
$5,000

$1,500
$7,500

$2,500
$10,000

$3,500
$20,000
Family

$1,500
$10,000

$3,000
$15,000

$5,000
$20,000

 $7,000
$40,000

$1,500
$10,000

$3,000
$15,000

$5,000
$20,000

 $7,000
$40,000
Calendar Year
Out-of-Pocket
Maximum		 Individual

Your deductible plus $3,000

Your deductible plus $3,000
Family

Your deductible plus $6,000

Your deductible plus $6,000
Medical Services

 SmartSense Plus Open Access POS
These amounts show your share of costs

 SmartSense Plus PPO
These amounts show your share of costs
Doctor's Office Visits
(PCP and Specialists)

$30 copayment for the first 3 visits per member per year
not subject to deductible.

After 3 visits, once deductible is met, member pays 30%

$30 copayment for the first 3 visits per member per year
not subject to deductible.

After 3 visits, once deductible is met, member pays 30%
Preventive Care (submitted as preventive care)

$0

$0
Professional Services
(x-ray, lab, anesthesia, surgeon, diagnostics, etc.)

Member pays 30% after
annual deductible

Member pays 30% after
annual deductible
Hospital Inpatient
(overnight hospital stays)

Member pays 30% after
annual deductible

Member pays 30% after
annual deductible
Hospital Outpatient
(if you don't stay overnight)

Member pays 30% after
annual deductible

Member pays 30% after
annual deductible
Emergency Room Care (Accidental injury or Medical Emergency as defined by BCBSGa)

$500 Copay
(waived if admitted)

$500 Copay
(waived if admitted)
Emergency Room Care (Non-medical emergency or non-serious accidental injury as defined by BCBSGA)

Member pays 30% after
annual deductible

Member pays 30% after
annual deductible
Maternity

Not covered

Not covered
Dental

Optional coverage available

Optional coverage available
Life

Optional coverage available

Optional coverage available
Vision

Not available

Not available
Prescription Drug Coverage

  SmartSense Plus Open Access POS
These amounts show your share of costs

  SmartSense Plus PPO
These amounts show your share of costs
Generic Prescription Drug Coverage
(some generics may be excluded)

$15 copay
(or 40%, whichever is greater) Not subject to deductible

$15 copay
(or 40%, whichever is greater) Not subject to deductible
Preferred Brand Prescription Drug Coverage
Includes select coverage of highly utilized brand-name drugs. Drugs were chosen based on evidence-based medicine. Plan does not include non-preferred brand name drugs. For more options see enhanced plan benefits below (additional charge for enhanced plan)

$15 copay
(or 40%, whichever is greater) Not subject to deductible

$15 copay
(or 40%, whichever is greater) Not subject to deductible
Comprehensive Drug Coverage Option - A separate $500 drug deductible applies to each member for Tier 2, 3 and 4 drugs (you must elect the "Comprehensive Drug Option" at the time of application to have access to this benefit)
See SmartSense Enhanced Plan Rates that include the Comprehensive Drug Option

Enhanced plan utilizes the comprehensive POS drug Formulary

Enhanced plan utilizes the comprehensive PPO drug Formulary
 Tier 1 - $15  Tier 2 - $30*  Tier 3 - $60*  Tier 4 - 40%*^  Tier 1 - $15  Tier 2 - $30*  Tier 3 - $60*  Tier 4 - 40%*^
* if brand is chosen when generic available, mbr pays copay, coinsurance plus the difference between brand and generic- $500 ded. applies for tier 2, 3 & 4
^ $4,000 yrly out of pocket maximum per mbr. applies for Tier 4 drugs		 * if brand is chosen when generic available, mbr pays copay, coinsurance plus the difference between brand and generic- $500 ded. applies for tier 2, 3 & 4
^ $4,000 yrly out of pocket maximum per mbr. applies for Tier 4 drugs

Waiting period for pre-existing conditions is 12 months from contract effective date. If you apply within 63 days of terminating your membership with another "creditable" health care plan, then you can use your prior coverage credit toward the 12 month waiting period.
*Refer to your individual certificate of coverage for complete benefit details including a full list of exclusions and limitations.
What is an Open Access POS Plan? Click here to find out.
  Click here to request that an enrollment package be emailed or mailed to you      

Agents are authorized agents for Blue Cross and Blue Shield of Georgia, Inc.
*Blue Cross and Blue Shield of GeorgiaI nc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc., are independent licensees of the Blue Cross and Blue Shield Association.
The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.


5 Dunwoody Park South
Suite 113
Atlanta, GA 30338

Call Chris, Holly or Bob at
(770) 396-9517
Outside of the Atlanta area,
call toll-free:
1-877-711-8376.
Email: holly@insurance-now.com